tbuckley/cabot-search huggingface dataset:
Abstract 15749: Outcomes of Fluoroless vs. Fluoroscopy-Guided Left Atrial Appendage Electrical Isolation During Catheter Ablation of Atrial Fibrillation
Authors: Jorge Romero, Mohamed Gabr, Isabella Alviz, Daniel Rodriguez, Sutopa Purkayastha, Luis Cerna, Jose Matias, Alejandro Velasco, Andrea Natale, Juan C Diaz, Jorge Marin, Domenico G Della Rocca, Luigi Di Biase
Journal: Circulation (2022)

Introduction: Fluoroscopy-guided catheter ablation remains a common practice. With the presence of technologies such as intracardiac echocardiography (ICE) and electroanatomic mapping (EAM), it is possible to perform fluoro- and lead-free procedures to avoid the hazards of prolonged radiation exposure. Left atrial appendage electrical isolation (LAAEI) is a proven e!ective ablation strategy for atrial fibrillation (AF). We sought to assess the characteristics, complications, and outcomes of fluoroscopy-guided LAAEI and compare them to fluoroless LAAEI. Methods: We retrospectively analyzed patients with AF who underwent LAAEI as part of their ablation procedure. The study group included patients who underwent LAAEI either under fluoroscopy guidance or with ICE and EAM alone. We analyzed outcomes and procedural data, including procedural times, fluoroscopy times, radiation exposure (mGy), and radiofrequency times. Results: Overall, we analyzed 168 patients who underwent LAAEI; 110 under fluoroscopy guidance and 58 fluoroless. The mean procedural time was similar in both groups (248 ± 101 vs 264 ± 83 minutes, respectively, p=0.27). The mean RF time was longer in the fluoroscopy-guided group (50 ± 28.2 compared to 43 ± 17.1 minutes, respectively, p&lt;0.001).The mean fluoroscopy time in the fluoroscopy-guided group was 25.3 ± 24.7 minutes, with mean radiation exposure of 177 ± 389 mGy. There was no difference in procedure-related complication rates ( 7 [6.3%] vs 4 [6.9%], respectively, p=0.89). At follow-up, there was no significant difference in arrhythmia recurrence rates (40.9% vs 31%, p=0.21). Conclusion: Fluoroless LAAEI is a safe and e!ective alternative to fluoroscopy-guided ablation, with the added benefit of averting the risks of ionizing radiation exposure. 1
Abstract 15467: Bi-Leaflet Tricuspid Valve in Children With Hypoplastic Left Heart Syndrome is Rarely Incompetent, While Bi-Leaflet With a Cleft Results in Tricuspid Valve Regurgitation
Authors: sultan zamzami, Tuqa Allawati, Lily Lin, Martha Moran, Luke Eckersley, Darren H Freed, Devilliers Jonker, Mohammed Al Aklabi, Nee Scze Khoo
Journal: Circulation (2022)

Introduction: Tricuspid valve (TV) regurgitation in Hypoplastic Left Heart Syndrome (HLHS) increases the risk of death/transplantation by 2 to 3 times. Abnormalities in TV annular shape, leaflets expansion and subvalve apparatus position, have been associated in HLHS with subsequent tricuspid regurgitation (TR). As TV morphological variation is increasingly recognized, its role on tricuspid valve function remains unknown. This study aims to describe and examine the relationship between the TV leaflet morphologies in HLHS and its association with TV repair. Methods: Cross sectional study of selected 38 “classic” HLHS patients from a prospective longitudinal 3DE study of HLHS TV. TV leaflet morphology from 3DE datasets were reviewed (S.Z and N.S.K) blinded to TR grade. We adapted a previously proposed nomenclature to describe the TV leaflets (Figure 1). Using the Chi-squared test, we compared the frequencies of TV morphological types of HLHS with mild or less TR (n = 23) vs. HLHS who had TV repair (n = 15) at latest follow up. Results: Incidence of TV morphological type is summarized in Figure 2. Bi-leaflet TV was the second most common, followed by bi-leaflet with a cleft. When comparing HLHS with mild or less TR vs. HLHS with TVR, only 1 of 9 bi-leaflet TV had subsequent TVR, while all bi-leaflet TV with a cleft, underwent TVR (p&lt;0.05). Conclusion: HLHS has considerable TV leaflet variations with bi-leaflet TV being the second most common variation. While bi-leaflet TV is more likely to be found in a competent TV, those with a bi-leaflet TV with a cleft, all required TVR. Bi-leaflet TV with a cleft, warrants further study to assess its relationship and relative role with TVR.
Abstract 15618: Contemporary and Emerging Training Pathways for Acute Care Cardiology: A Systematic Review
Authors: Scott Rose, Aryan Mehta, Mridul Bansal, Saraschandra Vallabhajosyula
Journal: Circulation (2022)

Introduction: Several studies have described trends toward increasing complexity and illness-severity of patients admitted to the cardiac intensive care units (CICU). This has necessitated the development of training pathways in critical care cardiology (CCC). Hybrid training in combinations of interventional cardiology (IC), advanced heart failure and transplant cardiology (AHFTC), and CCC have also gained interest. This review sought to outline current and proposed pathways for hybrid training in acute cardiovascular care. Methods: We performed a systematic review of articles describing training pathways for dual certification in CCC, as well as hybrid models for training in a combination of IC, CCC, and AHFTC. PubMed, EMBASE, and CINAHL were searched from 01/01/2000 to 04/28/2022. Pathways through pediatric and adult non-internal medicine specialties were excluded. Results: Of 2,236 citations, 18 studies were included in the final analysis. Most pathways included sequential CCC training, i.e. traditional cardiovascular fellowship and 1-2 additional years of critical care medicine, although integrated 4-year programs were noted to be emerging. Hybrid models for advanced training in two or more complementary subspecialties, including CCM, AHFTC, and IC, have been described, each with their own strengths and limitations. Additional expertise in advanced therapies such as mechanical circulatory support, the longitudinal AHFTC practice, and the combination of procedural and intensivist skills for management of diseases such as acute coronary syndromes were the stated benefits of these combined models. Alternatively, some advocate for incorporating focused CC training into a single year of IC or AHFTC fellowship. However, this may limit the time required to gain expertise in all areas of advanced training and is insufficient for board certification in CCM. Conclusion: Despite the growing need, there are limited dedicated pathways to train the contemporary acute care cardiologists. Further study is needed to consolidate training to encourage the growth and development of this field.
Abstract 15817: Hemodynamics of the UNOS Heart Allocation System: Is it Time to Add Objectivity to an Subjective System?
Authors: Mark N Belkin, Alejandro Plana, William F Parker, Sean P Pinney, Jonathan Grinstein
Journal: Circulation (2022)

Introduction: In the current United States Organ Sharing heart transplant allocation system, hemodynamic criteria, systolic blood pressure (SBP), cardiac index (CI), and pulmonary capillary wedge pressure (PCWP), are utilized to justify certain listing statuses. Hypothesis: We sought to identify how currently utilized, and advanced, hemodynamics discriminated patients by listing status. Methods: Retrospective analysis of the Scientific Registry of Transplant Candidates including all adults listed for heart transplant since the updated listing criteria went live in October 2018 was completed. In addition to SBP, CI, and PCWP, the mean advanced hemodynamic metrics of aortic pulsatility index (API), cardiac power output (CPO), left ventricular stroke work index (LVSWI), right ventricular stroke work index (RVSWI), and pulmonary artery pulsatility index (PAPI), were calculated for each status. Results: Since October 2018, 9,418 patients were listed for heart transplant, and 8,636 had complete hemodynamic data at time of listing. Currently utilized hemodynamic metrics failed to discriminate lower acuity statuses (3 through 6 for PCWP and CI; 4 through 6 for SBP). For advanced hemodynamic metrics, mean API was lowest for Status 1 patients, and rose consistently with increasing status with a clear stepwise and statistically significant difference for sequential statuses (p &lt; 0.001). CPO and LVSWI were unable to discriminate statuses 3-6. For right-sided hemodynamics, PAPI was unable to discriminate statuses 2 through 6, and there were no significant differences across any status for RVSWI. Conclusions: API is the only hemodynamic metric that is able to differentiate patients on the heart transplant waiting list across all active statuses by increasing in a stepwise fashion. Incorporation of API into future iterations of the UNOS heart allocation system may help better risk stratify patients and minimize waitlist mortality.
Abstract 15870: Integrated Transcriptomic and Proteomics Analyses Identify Lipid Metabolism as a Key Regulator of RV Size and Function in a Porcine Pulmonary Artery Banded Model
Authors: Jenna Mendelson, Michelle Doyle, Lynn Hartweck, Lauren Mills, Rajat Kalra, Cindy M Martin, Kurt W Prins
Journal: Circulation (2022)

Introduction: Right ventricular (RV) dysfunction is the leading cause of death in pulmonary arterial hypertension (PAH), but the molecular determinants of RV dysfunction are not well defined. In addition, most molecular evaluations of RV dysfunction use small animal models, and data from large animal models is sparse. Methods: Control and pulmonary artery banded (PAB) male piglets were subjected to cardiac MRI to quantify RV ejection fraction (EF), mass, and end systolic volume (ESV). Total RNA was isolated from RV free wall specimens and subjected to Next Gene RNAsequencing. RV mitochondrial enrichments were analyzed with quantitative mass spectrometry to define RV proteome changes. Bioinformatics analyses integrated transcriptomics, proteomics, and MRI data to identified pathways associated with RV dysfunction, hypertrophy, and volume. Results: Both transcriptomic and proteomic profiling revealed significantly different molecular signatures when comparing control to PAB piglets. Both analyses identified metabolism of lipids, lysosome, and mitochondrial fatty acid beta-oxidation pathways were associated with RVEF, while dilated cardiomyopathy, and arrhythmogenic RV cardiomyopathy pathways correlated with RV mass, and metabolism, metabolic pathways, citric acid cycle, and respiratory electron transport pathways were associated with RVESV. Fatty acid metabolism was identified on our analyses, and ferroptosis, a nonapoptotic form of cell death initiated by lipid peroxidation, was associated with RVESV and RV mass. Finally, in addition to coding genes we identified 72 lncRNAs that were strongly (r&gt;|0.85|) associated with RVEF. Conclusions: A combined proteomics and transcriptomics analysis identified multiple lncRNAs and lipid metabolism pathways associated with pathological RV remodeling and RV function. Future studies are needed to define how modulation of these pathways could impact modulate RV size and function in large animal models.
Abstract 15389: Insulin Like Growth Factor Binding Proteins 1 and 2 Are Prognostic Survival Markers in Intermediate Risk Pulmonary Arterial Hypertension
Authors: Megan Griffiths, Catherine Simpson, Jun Yang, Guillermo Torres, Dhananjay Vaidya, Stephanie Brandal, Michael Pauciulo, Rachel L Damico, Paul Hassoun, Dunbar D Ivy, Eric Austin, Erika Rosenzweig, Bill Nichols, Allen D Everett
Journal: Circulation (2022)

Introduction: Pulmonary arterial hypertension (PH) is an often fatal disease of the pre-capillary pulmonary vasculature. Recognizing high risk PH in ambulatory patients is important for optimization of therapy to improve outcomes. We previously identified insulin like growth factor binding proteins 1 and 2 (IGFBP1, IGFBP2) as prognostic markers in severe PH; here, we evaluated IGFBP1/2 as prognostic markers in PH with intermediate risk features. Methods: A multiplex ELISA assay measured serum IGFBP1/2 in the multicenter PH Biobank (N=2450), and independent validation cohorts (Johns Hopkins, N=145, Vanderbilt N= 128, 388 observations over time). IGFBP1/2 concentrations were compared to hemodynamics, six-minute walk (6MW), and WHO functional class using linear/logistic regression adjusted for age and sex. Time to death/transplant by IGFBP1/2 levels was assessed by Cox proportional hazard models. Analysis was repeated in subjects with low to intermediate risk features defined as WHO functional class 1-2, 6MW &gt;300 m, and NT-proBNP &lt;1500 pg/mL, based on the REVEAL and ERS risk scores. 1, 2 Results: In all cohorts, increased IGFBP1 and IGFBP2 were associated with lower cardiac output, higher mean pulmonary artery pressure and pulmonary vascular resistance (PVR, p&lt;0.05 for all). In each sub-analysis, a higher IGFBP1 and IGFBP2 was associated with lower cardiac output, lower systemic blood pressure, and higher PVR (p&lt;0.05 for all). Higher IGFBP1 and IGFBP2 were associated with shorter time to death/transplant in the overall cohort and each of the intermediate risk PH cohorts (Table 1), although underpowered in the Vanderbilt cohort. Conclusions: Identifying patients who will have adverse outcome in intermediate risk PH has proven challenging. These data suggest IGFBP1/2 are good prognostic markers in PH where functional class and exertional tolerance is preserved. IGFBP1/2 could further discriminate adverse outcomes in patients with low to intermediate risk PH.
Abstract 15458: Incidence of Ventricular Arrhythmias Related to Covid Infection and Vaccination in Patients With Brugada Syndrome: Insights From a Large Italian Multicenter Study
Authors: Sergio Conti, Antonio Dello Russo, Paolo Compagnucci, Francesca Massara, Claudio Tondo, Valentina Ribatti, Lorenzo Marcon, Gemma Pelargonio, Maria Lucia Narducci, Luca De Francesco, Leonardo Calo, Annamaria Martino, Cristina Balla, Saverio Iacopino, Giuseppe Sgarito, Giuseppe Patti, Chiara Ghiglieno, Gabriele Dell'Era, Giovanni B Forleo, Marco Schiavone, Michela Casella
Journal: Circulation (2022)

Introduction: Brugada syndrome (BrS) is an inherited channelopathy leading to an increased risk of life-threatening arrhythmias. BrS patients have a dynamic ECG pattern that might be revealed by certain conditions such as fever. Covid infection/vaccination is associated with fever. Therefore, prompt treatment with antipyretic drugs is recommended. Hypothesis: We evaluated the incidence and management of fever-related arrhythmias from Covid infection/vaccination among BrS patients previously implanted with an implantable loop recorder (ILR) or an implantable cardioverter-defibrillator (ICD) and followed by remote monitoring. Methods: 326 patients were retrospectively analyzed in 9 Italian Centers with a dedicated inherited disease ambulatory. All patients had a previously implanted device (ICD/ILR) and remote monitoring. We recorded ventricular arrhythmias (non-sustained VT, VT, FVT, VF) 6-month before Covid infection/vaccination, during Covid infection, at each vaccination, and up to 6-month post-Covid healing or 1-month after the last dose of vaccine. In ICD patients, we documented any device intervention (ATP/shock). Results: Mean age was 48.02±14.08, 240 patients were males (73.6%). 235 patients had an ICD (72.1%), and 91 had an ILR (27.9%). 175 patients had a spontaneous type 1 ECG pattern (53.7%). Fever occurred in 18.4% of all patients. The mean temperature was 38.2±0.6 degrees, 2.76% were hospitalized due to Covid. All patients developing fever received paracetamol, only a minority ibuprofen, antibiotics, and hydroxychloroquine. After Covid, we recorded 2 VT episodes in the same patient treated with paracetamol and hydroxychloroquine. After the 1st, 2nd, and 3rd vaccine doses we recorded: 10 NSVT; 16 NSVT and 2 VT; and 7 NSVT, respectively. After 1-month from the last dose, only 1 patient had an episode of FVT. The overall incidence of sustained VT is 1.2%. No ICD interventions, ATP and shocks, were recorded in the ICD population. Patients with an ILR had no ventricular arrhythmias. Conclusions: From this large multicenter study, fever treatment in patients with BrS is widely performed with paracetamol. The overall incidence of sustained ventricular arrhythmias after Covid infection/vaccination is relatively low.
Abstract 15241: Mixed Meal Tolerance Test Elicits Distinct Metabolite Kinetics for Individuals With and Without Diabetes
Authors: Michael Y Mi, Mark Whitlock, xu shi, Laurie A Farrell, Victoria M Bhambhani, Juweria Quadir, Matthew Blatnik, Kyle P Wald, Brendan Tierney, Albert Kim, peter loudon, Zsu-Zsu Chen, Rachel J Roth Flach, Robert E Gerszten
Journal: Circulation (2022)

Introduction: Branched chain amino acids (BCAA) are strongly associated with incident diabetes and CVD, and drugs that target their metabolism, especially in the context of a meal, are emerging treatments for diabetes given supportive genetic data. However, little is known about how BCAA, their breakdown metabolites—branched chain ketoacids (BCKA), and other metabolites change after a meal. Hypothesis: BCAA and BCKA levels are higher in individuals with diabetes after a mixed meal tolerance test (MMTT) than in those without diabetes, and a MMTT will uncover additional metabolites involved in dysregulated metabolic pathways secondary to diabetes. Methods: We administered a MMTT to 13 adults with diabetes treated by metformin alone and 11 age and sex matched controls. We measured BCKA, BCAA, and 194 metabolites at 8 timepoints across 6 hours. We used a mixed model for repeated measurements to compare between group differences at each timepoint with adjustment for baseline levels. Results: Across the participants (57 ± 8 years, 71% female, BMI 28 ± 4 kg/m 2 ), adjusted BCAA levels were similar at all timepoints between groups, but adjusted BCKA levels were higher in those with diabetes at 120 minutes (Figure). An additional 9 metabolites had 4 or more timepoints with significant between group differences (Figure). Acylcarnitine, palmitic acid, and linoleic acid showed slower rates of decrease and recovery in those with diabetes, altogether supportive of impaired fatty acid uptake and oxidation. Glycocholic acid showed no increase in those with diabetes, a finding that requires further study given growing recognition of bile acids’ paracrine effects on the liver. Conclusions: In contrast to BCAA, BCKA remained elevated after a MMTT in those with diabetes, suggesting that BCKA catabolism may be a key dysregulated process in the link between BCAA and diabetes. Other metabolites with different kinetics after a MMTT may be markers of dysmetabolism and impaired nutrient handling.
Abstract 15535: A Case of Suspected Menstruation Induced QTc Prolongation Leading to Torsades De Pointes
Authors: Adam Gardy, Joselyn Miller, Ippokratis Konstantinidis, Jennifer Ferreira, Chad Conner, Stephanie Saucier
Journal: Circulation (2022)

Estrogen is known to produce changes in cardiac electrophysiology specifically in premenopausal women, increasing the risk of arrhythmias. We report a case of Torsades de Pointes (TdP) in a young premenopausal female. A 25-year-old female with a history of anxiety presented to the emergency room (ED) with several days of vomiting. While in the ED, she had an unwitnessed syncopal event, and was found to be in pulseless ventricular fibrillation (V-Fib) . She required one defibrillation to obtain return of spontaneous circulation (ROSC). Initial work up showed calcium 7.6 mg/dl, phosphorous 1.1 mg/dl, magnesium 2.4 mg/dl, potassium 4.0 mg/dl. Remainder of electrolytes were normal. Toxicology screen was positive for cannabinoids. Post ROSC EKG showed sinus tachycardia at a rate of 103bpm with a prolonged QTc of 531ms. Patient was not on any medications outpatient. On further discussion, patient reported no prior history of syncopal episodes, palpitations, and denied any family history of sudden cardiac death. She did report she was presently on her menses. Shortly after admission, she had recurrent polymorphic ventricular tachycardia which degenerated to TdP. She was loaded with magnesium. Echocardiogram showed an ejection fraction (EF) of 35-39% and global hypokinesis. Diagnostic left heart catheterization was performed revealing clean coronaries. Cardiac MRI revealed EF of 43% without any late gadolinium enhancement. Her QTc remained prolonged even with electrolyte normalization. She underwent successful ICD placement and remained event free during the remainder of the hospital course. She will undergo genetic work up for long QT syndrome. Female sex hormones, specifically estrogen, have been described in literature as pro-arrhythmic given its effects on QT prolongation and ion gated channels. Prior cases of menstruation dependent arrhythmias have speculated that the abrupt reduction in estradiol prior to menstruation is associated with increased cyclic adenosine monophosphate dependent arrhythmogenicity. This case highlights the multifactorial etiology of sudden V-Fib arrest in a young female, and the importance of understanding the role that sex hormones play in the underlying pathogenesis.
Abstract 15644: Health-Related Quality of Life in Survivors of Cardiac Arrest: A Community-Based, Age-Stratified Analysis
Authors: Ziana Bhanji, Faye L Norby, Chad Sorenson, Bernadine Dizon, Madison Seifer, Audrey Uy-Evanado, Arayik S Sargsyan, Jonathan Jui, Angelo Salvucci, Sumeet S Chugh, Kyndaron Reinier
Journal: Circulation (2022)

Introduction: Health-related quality of life (HRQoL) is affected after out-of-hospital cardiac arrest (OHCA), but HRQoL scores in OHCA survivors are largely reported as a homogenous group. We performed a community-based evaluation of HRQoL scores in OHCA survivors and report the results stratified by age. Methods: We captured all residents of Multnomah Co., OR, and Ventura Co., CA who survived an OHCA during 2015-2021. We consented 197 survivors into our study and asked survivors to complete the Short-Form-36 Health Survey Version 1 (SF-36) to assess HRQoL at the time of the interview. The median time from OHCA to SF-36 interview date was 10 months. Scores for the 8 health domains of the SF-36 were calculated, and we used an independent sample t-test to compare the continuous scores of OHCA survivors to age-and-sex-standardized scores in the general population. Results: Of the 185 adult survivors who completed the SF-36 interview data (94% of those consented), the mean (SD) age was 60 (15) years and 58% were male. Overall, survivors had lower physical (p=0.0002) and emotional (p=0.01) health scores and lower social function (p=0.05) compared to the general population. We observed several age-domain interactions and split our sample into 3 age categories to explore HRQoL by age. Younger individuals (age 18-44, n=23) had similar HRQoL compared to the same ages in the general population. Older individuals (age 65+, n=78) also experienced similar HRQoL but reported better general health compared to the general population. Middle-aged survivors (age 45-64, n=84) reported lower physical function (p=0.05), physical problems (p=0.0009), emotional health (p=0.04), and social function (p=0.05) scores compared to the general population (Figure). Conclusion: HRQoL scores in survivors of OHCA were affected by age and were observed to be lowest in the middle-age subgroup. Targeted interventions in middle-aged survivors may have the greatest impact on improved HRQoL following OHCA.